[HSF] the great con...... another ONvOFF debate
Tea Acuff
tacuff at swbell.net
Fri Dec 28 20:15:33 EST 2007
Hang in there, Don.
OPCAB has its place and if in your hands you have the excellent results that you say its place is almost all time.
If there are virtuosos in music the main difference between someone who can play for the Met or someone who can read the music and can find the notes is 10,000 hours of practice. Perhaps not the only difference, but one most of us will not be able to recognize.
tea
----- Original Message ----
From: don ross <donross at bigpond.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Friday, December 28, 2007 7:24:05 PM
Subject: Re: [HSF] the great con...... another ONvOFF debate
Dear M & Z,
Sorry about the below the belt "comment"; I just wanted to stir but
not to burn the friendship.
However, given your combined claim that opcab is just too stressful
to attempt in all cases despite your apparent excellent training is
beyond understanding, based my experience.
If it is agreed that to be competent in opcab is desirable so
particularly suitable cases can bask in it's advantages means you
agree there is a benefit!
Why not find out how to offer this benefit to all patients?
Many surgeons are not comfortable with beating heart surgery and they
should not do it at all because it will eventually rise up and bite
them.
So my original thesis still holds: It is possible for plenty of us to
do this surgery safely, without stress and with, dare I say, a
similar sense of achievement to the mitral repair artists.
While on that subject, Hal, I bet you needed a fair bit of travel and
training to achieve alacrity with mitral repair?
This of course now begs the question: Is part time obcab surgery as
dubious an adventure as occasional mitral repair?
And BTW, Hal, that deadly conversion business you quote so frequently
was the product of inadequate training
and experience and is a thing of the past for comfortable obcabers.
If it wasn't we would be, most certainly, back on the breast.
Happy new year .
Don
n 28/12/2007, at 11:23 AM, zzhoumd at pol.net wrote:
> Don,
>
> Just wonder what is "informed comments".
>
> Z Zhou
>
>
> Sent via BlackBerry by AT&T
>
> -----Original Message-----
> From: don ross <donross at bigpond.com>
>
> Date: Fri, 28 Dec 2007 09:18:47
> To:OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] the great con...... another ONvOFF debate
>
>
> Michael & Zhou,
> You both need to learn from surgeons who do opcab as a routine,
> without stress and anxiety.
> Then you will be able to make informed comments in this debate.
>
> There must be a few such surgeons in USA so you will not need go to
> India where you could see 20 opcab cases a day in many units.
>
>
> Don
>
>
> On 28/12/2007, at 8:12 AM, zzhoumd at pol.net wrote:
>
>> Michael,
>>
>> That is my point, I wish we could come up with a formula that can
>> calculate that.
>>
>> In fact, it dose take a lot of calculation in my mind every time I
>> try something new. About a third of my cases now are done with new
>> approaches.
>>
>> Z Zhou
>>
>>
>> Sent via BlackBerry by AT&T
>>
>> -----Original Message-----
>> From: "Michael Firstenberg" <msfirst at gmail.com>
>>
>> Date: Wed, 26 Dec 2007 15:40:56
>> To:OpenHeart-L at lists.hsforum.com
>> Subject: Re: [HSF] the great con...... another ONvOFF debate
>>
>>
>> OK, I know why I do not like OPCAB - so why do the vast majority of
>> surgeons
>> who make their livings (and who constantly get beat for faster,
>> cheaper,
>> safer, yadda yadda yadda) doing CABG not like it? I can understand
>> people
>> who do not feel comfortable with valve repairs - since they would
>> see so few
>> in a year or valve sparing roots - but what are the deeper causes
>> of why
>> people do not perform OPCAB - I guess I am looking for more
>> philosophical
>> reasons than technical ones. Maybe the point is finding the
>> benefit v
>> effort v risk v comfort balance?
>>
>> -michael
>>
>>
>>
>>
>> On 12/26/07, zzhoumd at pol.net <zzhoumd at pol.net> wrote:
>>>
>>> Ani,
>>>
>>> If the benefit is well worth the effort, I am sure a lot of people
>>> will do
>>> it and do it well. Although I had a lot of training in OPCAB, just
>>> do not
>>> have the motivation to do it on every patient. It is just more
>>> stress for
>>> both anesthesia and surgeons.
>>>
>>> Z Zhou
>>>
>>> Sent via BlackBerry by AT&T
>>>
>>> -----Original Message-----
>>> From: Ani Anyanwu <anianyanwu at hotmail.com>
>>>
>>> Date: Wed, 26 Dec 2007 19:25:39
>>> To:<openheart-l at lists.hsforum.com>
>>> Subject: RE: [HSF] the great con...... another ONvOFF debate
>>>
>>>
>>> Michael
>>>
>>> Yes it is that a different operation. Ability to do complex
>>> conventional
>>> surgery does not mean one can replicate it if done in mini-
>>> invasive or
>>> off-pump fashion
>>>
>>> That one pioneered complex mitral repairs does not mean one can
>>> also do it
>>> with a robot or endoscopic assist. That one has done lobetomies
>>> for last 50
>>> years does not mean one can do a VATs lobectomy. That one
>>> pioneered CABG
>>> does not mean one can adapt to do it off-pump. That the big names at
>>> Cleveland do not do OPCAB does not to me mean much - it is more
>>> likely to
>>> mean they do not know how to do it, do not want to learn how to do
>>> it or
>>> have tried it and could not do it as well as their tried and tested
>>> technique. Afterall how do you explain the fact that only about
>>> 20% patients
>>> at CCF have bilateral mammary artery grafts when the clinic are
>>> the ones who
>>> provided the most compelling data to support the approach. Even if
>>> all
>>> randomized trials showed OPCAB to be superior I bet you they still
>>> would not
>>> be doing it at all CCF (partly for reasons I outlined in a post 2
>>> days ago).
>>>
>>> Ani
>>>
>>>
>>>
>>>
>>>> Date: Wed, 26 Dec 2007 14:06:09 -0500> From: msfirst at gmail.com> To:
>>> OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] the great
>>> con......
>>> another ONvOFF debate> CC: > > wait a minute - I thought people
>>> are saying
>>> that the "skill oriented factor"> is trivial?> or the cardiac
>>> pioneers to
>>> developed all of the new skills, tricks, and> operations (valve
>>> repairs,
>>> switches, transplants, etc) dont (or wont) have> the skills for
>>> off-pump or
>>> that is it such as different operation????> > > > > -michael> > >
>>>>> On
>>> 12/26/07, Prasanna Simha M <prasannasimha at gmail.com> wrote:> >> >
>>> Why is
>>> it popular in India - economics.(Reusable/Resterilized stabilizers)
>>>>> Why
>>> is it unpopular in US - there is no advantage economically there
>>> so> > why>
>>>> use a more "skill oriented technique" which may give you a few
>>>> grey hairs>
>>>> when there is no difference and with the potential for
>>>> litigation ?> >
>>> Prasanna> >> > On Dec 26, 2007 10:32 PM, Michael Firstenberg <
>>> msfirst at gmail.com> wrote:> >> > > On 12/26/07, don ross <
>>> donross at bigpond.com> wrote:> > > >> > > > Michael,> > > > You are
>>> correct
>>> in your assessment of the penetration of opcab and I> > > > find
>>> it a bit
>>> puzzling.> > > >> > > > Perhaps I was lucky with my anaesthetists
>>> and the
>>> fact that I seem to> > > > have developed a simple technique, the
>>> key to
>>> which is the home made> > > > shunts and having no hesitation to
>>> use the
>>> pump if needed. (but no> > > > aortic clamp)> > > >> > > > It is
>>> true that
>>> it is not for everyone as I have trained some> > > > surgeons to do
>>> competent opcab who ,nevertheless, have fallen back> > > > into
>>> the bosom of
>>> cardioplegia.> > > >> > > > Although no one will believe it , I
>>> have done
>>> 1000 anaortic opcabs> > > > with no strokes so I can't help
>>> believing that
>>> some of the last few> > > > morbidity percentage points can be
>>> addressed.> >
>>>>> Don> > >> > >> > > Don,> > > I am glad for you and your patients
>>>>> that
>>> you are getting good OPCAB> > > results. There is no doubt that
>>> eliminating
>>> bypass can eliminate some> > of> > > the M&M of heart surgery, but
>>> I think
>>> we are being unrealistic in> > thinking> > > that all of the M&M is
>>> associated with CPB with/without aortic clamping> > -> > > not to
>>> mention
>>> the variety of problems which can be introduced that are> > >
>>> unique or more
>>> common with OPCABs.> > >> > > I guess those of us who do a lot of
>>> On pump
>>> can justify it for many> > > reasons> > > - which begs the
>>> question to the
>>> hard core off-pumpers to come up with> > > answers (real answers)
>>> why the
>>> vast majority of surgeons in this country> > > (US> > > if not the
>>> world)
>>> still use a technique that is more expensive and time> > >
>>> consuming and "in
>>> theory according to the literature" associated with> > more> > >
>>> deaths and
>>> awful complications. Anyone know of a lawsuit were someone> > >
>>> said> > >
>>> "Mr X would not have had this complication has this surgeon not
>>> comitted> >
>>>> malpractice and crimes against humanity by using CPB"? As a
>>>> group, we> >
>>> tend> > > to willingly accept advances in technology over time, so
>>> why has
>>> this> > not> > > caught on?> > >> > > -michael> >
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